By Nicholas Bamonte

Humans are incredibly complex creatures, a billion layers folded into one. Each person is distinct, with so many variations among these layers and traits throughout the billions of humans on this planet. If these variations and how they interact with each other can affect something as seemingly consistent and deterministic as biochemistry and interactions between medications, imagine how they can affect something more aethereal, like our minds. October is ADHD Awareness Month, a fact that helps to show just how far ADHD has come in public awareness and acceptance. In fact, it’s the 20th anniversary of the first ADHD awareness day. We’ve come such a long way, and yet, I can’t help but be a bit of a stick in the mud. ADHD is not simple or uniform, but whether due to the traditions of standard medical practice or being simplified for mass consumption, we often treat it as if it were.

The stereotype of a person with ADHD is a young hyperactive boy who can’t sit still in class, fidgeting and looking every which way. Now, while this image is correct from a strictly definitional perspective, it is so overly simplistic and shallow as to be functionally useless, failing to capture the broad strokes of the average lived experience with ADHD. For one thing, ADHD is widely understood to be a product of genetic and brain structure factors, meaning that it is an inherent, lifelong condition, and not one in which a person merely “grows out” of it. The recent surge of adults seeking diagnoses and treatment for ADHD has highlighted how little research and attention has been given to the disorder outside of the realm of children.

Another failure born from this stereotype is in the realm of girls with ADHD. Currently, ADHD is overwhelmingly diagnosed in boys as opposed to girls, but this difference is largely believed to be more the result of ADHD research being overwhelmingly geared towards how it manifests in boys rather than girls. Whether through inherent biological differences or the social roles enforced upon children, girls tend to manifest less obvious or stereotypical symptoms of ADHD. Like with adults, even though the hyperactivity and other symptoms are more “muted”, or subtle, that does not stop them from struggling and needing assistance, which they often do not get and are left to suffer in silence.

“Even after all that has been said, there is still so much more to talk about. ADHD is a condition that frequently occurs alongside a number of other learning and developmental disorders, such as dyslexia and autism spectrum disorder. ”

Modern ADHD experts generally agree that the disorder can be broken down into three subtypes or “presentations” of symptoms. The first is inattentive type ADHD, where the main symptoms experienced are difficulties with maintaining or focusing attention, and heightened distractibility. This subtype is essentially what was once considered the separate diagnosis of Attention Deficit Disorder (ADD), or ADHD without the hyperactive component. In this type of ADHD, a person will primarily struggle with controlling those mental processes called “focus” and “attention”, or in other words, our ability to control our thoughts and behaviors for a specific task or purpose.

The second form is hyperactive and impulsive type ADHD, where a person struggles with the impulse control and hyperactive behavior. This is believed to be the result of a break down in the cognitive processes used to regulate and inhibit certain thoughts and behaviors. The third and final form is combined type ADHD, where a person experiences a roughly equal number of symptoms associated with the other two subtypes. While the combined type is the most prevalent type of ADHD, to ignore the reality that there are people who only experience a portion of the “usual” ADHD symptoms is a disservice, one that all but guarantees many will “fall through the cracks.” Poor impulse control and difficulty consciously controlling attention are hard enough to deal with by themselves, and even struggling with one or the other, a person is more than entitled to the same help and resources that we offer to the more “typical” form of ADHD.

Finally, while not an official symptom or component of ADHD, many clinicians and experts make a connection between ADHD and an impairment in “executive function,” the cognitive processes that allow us to organize our thoughts, plan out our actions, manage time, prioritize tasks, and make decisions. In other words, our executive functions can be thought of as our internal “mental secretary” that serves to organize and manage the rest of our cognitive processes. Now, looking back at the symptoms described for the inattentive and hyperactive and impulsive subtypes of ADHD, I hope it becomes self-evident why many link ADHD with executive dysfunction. Organizing thoughts, planning out actions, managing time, making decisions, and other similar tasks are all heavily dependent on one’s ability to control one’s own thoughts through keeping large swaths of information in one’s working memory, focusing on those thoughts, and inhibiting stray thoughts from coming in and overwriting important information within one’s working memory. It should be no surprise why the symptoms of executive dysfunction can often better describe the practical experience of people with ADHD than simply saying they’re distractible and impulsive.

Even after all that has been said, there is still so much more to talk about. ADHD is a condition that frequently occurs alongside a number of other learning and developmental disorders, such as dyslexia and autism spectrum disorder. Certain symptoms are even shared by these comorbid diagnoses. These similar and different symptoms can interact and create even more complicated issues within a person’s life. There’s also how these symptoms can interact with other aspects of a person’s life to create entirely new and seemingly unrelated issues. For example, a young boy coming to feel isolated among his friends because he struggles with time management and can’t keep up with social events and trends.

Just as there has been a move to embrace a more holistic view of the body and health in traditional medicine, so too must we embrace a more holistic view of mental health and psychology if we ever hope to truly understand and address the full range of symptoms and effects of these conditions. ADHD, with its relatively high diagnosis rate among the general populace, comorbidity with other learning and developmental disorders, varied symptoms, and disruption of basic functions that affect all aspects of one’s life, makes it both a perfect example and a perfect starting point.

References

ADDA Editorial Team. “Executive Function Disorder & ADHD: Adda.” ADDA - Attention Deficit Disorder Association, July 23, 2024. https://add.org/executive-function-disorder/.

“Attention Deficit Hyperactivity Disorder (ADHD) - Symptoms.” NHS choices. Accessed October 6, 2024. https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/symptoms/.

Barkley, Russell. “What Is Executive Function? 7 Deficits Tied to ADHD.” ADDitude, January 29, 2024. https://www.additudemag.com/7-executive-function-deficits-linked-to-adhd/.

Kulman, Randy. “Children with Slow Processing Who Need Extra Time on Tests.” Psychology Today, August 9, 2019. https://www.psychologytoday.com/us/blog/screen-play/201908/children-with-slow-processing-who-need-extra-time-on-tests.

“Symptoms of ADHD.” Centers for Disease Control and Prevention, May 15, 2024. https://www.cdc.gov/adhd/signs-symptoms/index.html.

“Types of ADHD in Adults: Understanding the Differences.” ADDA - Attention Deficit Disorder Association, May 3, 2024. https://add.org/adhd-types/.

“Where Did ADHD Awareness Month Get Its Start?” ADDA - Attention Deficit Disorder Association, October 7, 2024. https://add.org/adhd-awareness-history/

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